Abstracts

A retrospective review of a large contemporary surgical series from a single center by one surgeon is presented. The series spans 8 years. Demographics, outcome, efficacy, complications, patient selection criteria, general surgical technical descriptions, and surgical philosophy are discussed.
Data is from 944 craniotomies, 88 bilateral invasive surveys, 69 1-stage resections, 369 2-stage procedures, 42 3-stage procedures, 296 vagal nerve stimulator operations, and 38 stereotactic procedures. 695 unique patients underwent 480 craniotomies. Average age for patients with craniotomy was 31 +/-12 years and 47 percent were female. Outcome reporting uses minimally modified Engel scores.
1-stage resections (primarily anterior medial temporal lobectomy with hippocampectomy) when stratified by Engel scores 1/2/3/4 respectively comprised 91/6/4/0% of the entire group, with 76% follow up. 2-stage procedures, involving invasive VEEG prior to resection, had respective outcome scores 64/14/14/8% with 81% follow up. 3-stage procedures yielded outcome stratification 50/19/28/3% with 76% follow up. 1, 2, and 3 stage operations where associated with decreases of 3 full Engle grades between pre-op and post-op states in 83%, 53%, and 41% respectively. Demographics of the patient group without outcome statistics because of outstanding follow up data are not different from demographics of the reported outcome group. Demographics and complications are reported for all patients. The majority of follow data is over 2 years out from surgery. In this entire series there was no mortality and important morbidity were infrequent. The entire cranial series had 15 infections and 9 hemorrhages representing respective relative risk of 1.0% / 1.8% for hemorrhage and 1.6% / 3.1% risk for infection per craniotomy / per patient. Other common morbidities are subdural hygromas, hydrocephalus, memory deficits and 3rd nerve injury with respective incidence of 0.4% / 0.8%, 0.1% / 0.2%, 0.5% / 1.0% and [gt]0.1% / [gt]0.1%. Bone resorption requiring cranioplasty occurred in 3 patients. No vascular injury with symptomatic or functional results occurred.
There was no mortality in this entire series and important morbidity and complications were infrequent. The most common morbidities were hemorrhage and infection. Single and multi-stage procedures have acceptable important risks and excellent to good seizure control.